Every September, the Substance Abuse and Mental Health Services Administration (SAMHSA) sponsors National Recovery Month in an effort to increase awareness and understanding of substance use and mental health disorders, and to honor and celebrate the people who recover. The theme for 2017 is “Join the Voices for Recovery: Strengthen Families and Communities”.One of the most prevalent issues individuals and families face in their journey of recovery is trauma, or the way in which they perceive and experience major life events. As we’ve written in the past, trauma is completely subjective and, if untreated, can lead to the use of behaviors and substances to escape the effects of trauma.

This year, Roots Through Recovery is honored to celebrate Recovery Month with a special speaking event with Deborah Sweet, Psy.D.: “The Nuances of Trauma Treatment: What to use, how and when”. Treating trauma is it’s own specialized area of psychotherapy. Specific tools and modalities are needed to help people recover from the effects of trauma. Trauma is held in the subcortical region of the brain therefore traditional therapy, though wonderful, will not move traumatic incidents the way that EMDR, Brainspotting, Somatic or Havening therapies do. In this talk, Dr. Sweet will provide information on types of treatment and when and how to use them.

Title: “Nuances in Trauma Treatment: What to use, how and when”Date: Wednesday, September 27thTime: 11:00am to 1:00pmLocation: 3939 Atlantic Avenue, Suite 102, Long Beach, CA 90807

Deborah Sweet, Psy.D. is a licensed psychologist, trauma expert and Founder of the Trauma Counseling Center of Los Angeles. Treatment at TCCLA focuses on helping people recover from the overwhelming effects of trauma using modalities that are specifically designed to help people recover from trauma. These cutting-edge modalities include the Somatic therapies of Somatic Experiencing, Sensorimotor Psychotherapy and the Trauma Resiliency Model; EMDR, Brainspotting and the Havening Technique. At the Trauma Counseling Center of Los Angeles, the team helps individuals clear traumas by engaging the subcortical regions of the brain to restore resiliency to the nervous system, enable clearer thinking and an ability to enjoy life more fully.

Lunch will be provided, thanks to our event sponsor WEconnect Recovery. The event is completely FREE, but you must RSVP, and seats are limited.

EMDR has received some notable attention recently thanks to its effectiveness in treating trauma. There is a lot of information available online and in academic literature of the therapy, so we put together this article as an overview of EMDR to help you understand what it is and how it works.

So what exactly is EMDR and how does it work?

EMDR stands for Eye Movement Desensitization and Reprocessing, and it involves 8 phases including the use of eye movement, or bilateral stimulation, which appears to be similar to what occurs naturally during dreaming or REM (rapid eye movement) sleep. As we wrote about in past blogs, when a person experiences a traumatic event, their brain goes into defense mode and changes its function.

One of these functions includes the hippocampus, which usually works to store memories in a neat filing system that allows us to easily and accurately recall these memories. When faced with a threat, the hippocampus takes on the role of pumping cortisol throughout the body so that we don’t feel pain, and puts the memory storage on the back burner. So it’s no wonder it’s incredibly difficult to recall a traumatic event, or we recall it inaccurately by filling in the blanks later on.

EMDR allows us to go deep into the brain and file these memories with the appropriate meanings and emotions attached to them. According to the EMDR International Association, the goal of EMDR is to:

“Process completely the experiences that are causing problems, and to include new ones that are needed for full health… That means that what is useful to you from an experience will be learned, and stored with appropriate emotions in your brain, and be able to guide you in positive ways in the future. The inappropriate emotions, beliefs, and body sensations will be discarded… The goal of EMDR therapy is to leave you with the emotions, understanding, and perspectives that will lead to healthy and useful behaviors and interactions.”

One of the leading experts on developmental trauma and author of The Body Keeps the Score, Dr. Bessel van der Kolk recalls the experience he had using EMDR on a patient when he realized the power of the therapy. Watch below:

What are the 8 phases of EMDR?

Phase 1: The first phase is a history-taking session(s). The therapist assesses the client’s readiness and develops a treatment plan. Client and therapist identify possible targets for EMDR processing.

Phase 2: During the second phase of treatment, the therapist ensures that the client has several different ways of handling emotional distress. The therapist may teach the client a variety of imagery and stress reduction techniques the client can use during and between sessions. A goal of EMDR therapy is to produce rapid and effective change while the client maintains equilibrium during and between sessions.

Phases 3-6: In phases three to six, a target is identified and processed using EMDR therapy procedures. These involve the client identifying three things:

In addition, the client identifies a positive belief. The therapist helps the client rate the positive belief as well as the intensity of the negative emotions. After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously engaging in EMDR processing using sets of bilateral stimulation. These sets may include eye movements, taps, or tones.

Phase 7: In phase seven, closure, the therapist asks the client to keep a log during the week. The log should document any related material that may arise. It serves to remind the client of the self-calming activities that were mastered in phase two.

Phase 8: The next session begins with phase eight. Phase eight consists of examining the progress made thus far. The EMDR treatment processes all related historical events, current incidents that elicit distress, and future events that will require different responses.

From EMDR.com

Does it actually work?

At least 20 positive controlled outcome studies have been done on EMDR therapy. According to the EMDR Institute, which hosts a comprehensive list of EMDR-related research, some of the studies show that 84%-90% of single-trauma victims no longer have post-traumatic stress disorder after only three 90-minute sessions. Another study, funded by the HMO Kaiser Permanente, found that 100% of the single-trauma victims and 77% of multiple trauma victims no longer were diagnosed with PTSD after only six, 50-minute sessions.

EMDR International Association reports on the same topic, “Clients often report improvement in other associated symptoms such as anxiety. The current treatment guidelines of the American Psychiatric Association and the International Society for Traumatic Stress Studies designate EMDR as an effective treatment for post traumatic stress. EMDR was also found effective by the U.S. Department of Veterans Affairs and Department of Defense, the United Kingdom Department of Health, the Israeli National Council for Mental Health, and many other international health and governmental agencies. Research has also shown that EMDR can be an efficient and rapid treatment” (www.emdria.org).

Who does EMDR?

Only Masters-level or Doctoral-level professionals–therapists, nurses and doctors–who have gone through approved EMDR training can provide EMDR to people. Roots Through Recovery is proud to have two clinicians on our team that are trained and certified to provide EMDR. Clients who have undergone EMDR therapy for trauma have seen great improvement in their management of traumatic experiences, and how that plays a role in their addictions and mental health.

Roots Through Recovery opened its doors in January 2017 and in the last four months, the program has grown to include daytime partial hospitalization and morning intensive outpatient to meet the various needs of our clients. There has been a lot of interest in recent weeks for an evening intensive outpatient program for the working professionals in Long Beach and the South Bay.

In response to this growing need, Roots Through Recovery is excited to announce the start of its evening IOP program beginning the week of May 15th!

CALL NOW (562) 473-0827

Much like our daytime programs, the evening IOP program will focus on addressing underlying trauma and mental health needs of community members who are coping with alcohol or drug addiction. Our compassionate and highly trained therapists provide trauma-informed care in small groups and individual therapy.

Most people who work in recovery or are in recovery themselves, or both, would agree that social connections are important for long-term recovery from addiction. The level of external support individuals have is often referred to as Social Capital or Recovery Capital, which for the purpose of this article, we are defining as:

The abundance of positive social relationships and connections, specifically across the domains of social supports, spirituality, life meaning, and involvement in a recovery community.

Individuals coping with substance use or dependence are often treated as patients with an acute illness, as one would be treated in the ER or urgent care:

Assessment;

Intake;

Treatment; and

Discharge;

which research proves is not an effective approach to achieving sustainable recovery. Alexandre Laudet, PhD., Director of the Center for the Study of Addictions and Recovery (C-STAR) at the National Development and Research Institutes suggests that if one considers addiction to be a chronic condition, a conjecture increasingly accepted in the field, then being in remission (recovery) should be thought about in terms of a long-term process that unfolds over time, rather than a time-limited ‘event’.

The theory of recovery capital suggests that the more abundant our recovery capital, the greater the likelihood we will remain in recovery. We see the value of this connection to community at the very core of sober living environments and groups like Alcoholics Anonymous, an international fellowship of more than 2 million men and women with an alcohol dependence, and their associated groups including Narcotics Anonymous and Cocaine Anonymous. Not surprisingly, we see poorer outcomes and frequent relapse in those who leave treatment, even long-term treatment, without a social network to support them in recovery.

Longitudinal studies, like that of Dr. Laudet’s, exemplify the critical value of social and recovery capital at the various stages of recovery, allowing us to most effectively incorporate these practices into assessment, treatment planning and discharge planning. Whether you’re a staunch supporter of 12-step recovery, a believer in the value of psychotherapy or biomedical treatments, or have embraced the combination of these approaches, it is becoming increasingly more difficult to deny the impact of connections and social support in long-term recovery, both positive and negative.

Taking into consideration the number of connections isn’t enough to determine the impact they will have on an individual in recovery; rather, we must account for the value of each connection, or perceived value. The complex web below shows that our social and peer connections differ in impact based largely on perception. For example, communication can be seen as a sign of caring and concern–a component of emotional support–and therefore, helpful to recovery. In contrast, criticism (a form of communication) may be perceived as unsupportive and therefore harmful to recovery, regardless of intention.

What if having a large, closely-knit social and peer network was detrimental to recovery? The role of social networks and peer support in recovery has been studied for quite some time; and although the research overwhelmingly sways in the direction of the positive impact social networks play in our recovery, a recent NPR article about the increase in opioid abuse in rural communities–in sharp contrast–points to social networks as a main contributor.

The story follows Melissa Morris, whose story of addiction started like many others–with a prescription to Percocet, an opioid pain killer. She got hooked, and when the Percocet stopped getting her high, Morris then started injecting Oxycontin. After that, she got her hands on Fentanyl patches, a highly addictive and potent opioid, and would chew on them instead of applying them to skin as the package directed. When the prescriptions stopped coming, she turned to a cheap and easy option: heroin. Morris’ story is much like what we are seeing across the country, and especially in rural communities.

The facts:

The CDC reports three out of four new heroin users report abusing prescription opioids prior to trying heroin.

In the U.S., heroin-related deaths more than tripled between 2010 and 2015, with 12,989 heroin deaths in 2015.

According to the U.S. Centers for Disease Control and Prevention, opioids were involved in more than 33,000 deaths in 2015 — four times as many opioid-involved deaths as in 2000.

A recent University of Michigan study found the rates of babies born with symptoms of withdrawal from opioids rising much faster in rural areas than urban ones.

So what role do social networks play in the opioid epidemic? The publication about rural Colorado, titled “Rural Colorado’s Opioid Connections Might Hold Clues To Better Treatment”, in addition to limited access to alternative treatments for pain like physical therapy, found in speaking with individuals struggling with opioid addiction that these communities saw an increase in misuse and dependence because rural residents know and interact with roughly double the number of people an average urban resident does. Counterintuitively maybe, this “small town” social network provides members of rural communities twice the number of opportunities to access drugs, according to Kirk Dombrowski, a sociologist at the University of Nebraska-Lincoln.

“So some of those social factors of being in a small town can definitely contribute,” Dombrowski says.

But, like Dr. Laudet’s findings, the Colorado resident Melissa Morris describes how the size of your social network doesn’t define the risk, but rather, the value of the network is often at play. She says that close social ties in her town may have contributed to the spread of opioids there as those bonds can spread drug use quickly, however they can reduce the spread of drugs in other ways. Morris, who is now on Suboxone to help her with her opioid addiction, recently recruited two opioid-dependent friends to the clinic she goes to weekly for treatment.

“I used to sell them pill and heroin,” says Morris, who is now helping these friends get clean. “And so I do have hope. I’ve seen those success stories.”

This consideration of the value, and perceived value, of social networks has great implications for the field of addiction research and treatment. Often times, providers ensure clients broaden their social network and surround themselves with “positive influences”, but as treatment providers, it should be a regular practice to give individuals in recovery the tools needed to regularly take an inventory. We should assess the impact individuals have (are they helpful or harmful?) often as this can frequently change, as our once drug dealers can enter treatment and have a positive impact on our recovery.

I think all along we should have been singing love songs to them, because the opposite of addiction is not sobriety. The opposite of addiction is connection. –Johann Hari

In Johann Hari’s landmark TED Talk in June 2015, titled “Everything you think you know about addiction is wrong”, he explains the psychology behind addiction and how the criminalization of and stigma of the addicted person actually produce the opposite of the intended outcome. Saying “drugs are bad” and that they are addictive does nothing to address the issue of why people begin using drugs in the first place, such as to self-medicate or numb the unpleasant feelings brought on by past trauma, as we wrote about in an earlier blog. Hari says, essentially and quite simply, everything we’ve been doing to get people to stop using drugs has been wrong! And by the way, he didn’t arrive at this conclusion by chance or do it on his own; in fact, he had quite a bit of help from friends, scientists and the country of Portugal.

Hari first began to delve into this topic the way many of us have: because our lives have been touched by addiction, either we have experienced an addiction ourselves or someone close to us has. The fascinating thing about addiction is that the common societal attitude toward addiction is largely based on decades old research that has since been debunked, and yet, we continue to think that these two things are the key: 1. Drugs are addictive, and 2. People will stop using drugs if we punish them. The research, including that of Dr. Alexander referenced by Hari, shows that these two points are inherently wrong. Dr. Alexander’s famous “Rat Park” study tells us something different about addiction. Here is an excerpt from Hari’s TED Talk:

You get a rat and you put it in a cage, and you give it two water bottles: One is just water, and the other is water laced with either heroin or cocaine. If you do that, the rat will almost always prefer the drug water and almost always kill itself quite quickly. So there you go, right? That’s how we think it works.

In the ’70s, Professor Alexander comes along and he looks at this experiment and he noticed something. He said ah, we’re putting the rat in an empty cage. It’s got nothing to do except use these drugs. Let’s try something different. So Professor Alexander built a cage that he called “Rat Park,” which is basically heaven for rats. They’ve got loads of cheese, they’ve got loads of colored balls, they’ve got loads of tunnels. Crucially, they’ve got loads of friends. They can have loads of sex.

And they’ve got both the water bottles, the normal water and the drugged water. But here’s the fascinating thing: In Rat Park, they don’t like the drug water. They almost never use it. None of them ever use it compulsively. None of them ever overdose. You go from almost 100 percent overdose when they’re isolated to zero percent overdose when they have happy and connected lives.

Hari isn’t saying that the environment is necessarily to blame, either, but rather that connecting with a drug addicted person is far more effective than punishing them, and maybe it is the cage. Hari questioned the relationship between these rats and their park, and thought, maybe it’s only with rats. But then he considers what happened with human beings, young American service men in the Vietnam War, over forty years ago.

“In Vietnam, 20 percent of all American troops were using loads of heroin, and if you look at the news reports from the time, they were really worried, because they thought, my God, we’re going to have hundreds of thousands of junkies on the streets of the United States when the war ends; it made total sense”. The Archive of General Psychiatry followed these soldiers home and conducted a detailed study, and what actually happened to these soldiers shocked scientists and doctors who studied addiction. Hari goes on, “It turns out they didn’t go to rehab. They didn’t go into withdrawal. Ninety-five percent of them just stopped. Now, if you believe the story about chemical hooks, that makes absolutely no sense, but Professor Alexander began to think there might be a different story about addiction. He said, what if addiction isn’t about your chemical hooks? What if addiction is about your cage? What if addiction is an adaptation to your environment?”

We’ve seen time and time again in countries with harsh drug policy and limited views of addiction, including the United States, shaming and criminalizing drug use—throwing addicts into the criminal justice system—does nothing positive for the addicted individual. When a heroin addict is arrested for possession and spends time in jail, she comes out with a record, thereby making it even more difficult for her to get a job and secure housing, further limiting her connections, isolating and traumatizing her, and creating a void that can seemingly only be filled with substance use. So what if, instead of beating people down, we built them up? What if we loved them unconditionally, and take all the money we spend on cutting addicts off, on disconnecting them, and spend it on reconnecting them with society? That’s what Portugal’s national drug coordinator, Dr. João Goulão, asked himself.

In the year 2000, Portugal had one of the worst drug problems in the world, with one percent of its population addicted to heroin—an incredibly mind-blowing statistic. They had tried the American way of waging war on drugs, which is essentially a war on drug addicts, and found that what we know to be true here was true for them: it does not work, and it was getting worse every year. Fifteen years ago, Dr. João Goulão and a panel of experts sat together to address the problem, and considered all the research, and the country of Portugal did something monumental, something daring and seemingly crazy: they decriminalized ALL drugs. With their drug problem reaching unmatched heights at that point, Portugal’s decision had the whole world watching.

We know what happened, or didn’t happen rather: More people did not start using drugs. More people didn’t die from drug overdoses. What everyone thought was going to happen, didn’t happen. Drug use went down. WAY DOWN. Portugal went from having one of the worst heroin epidemics in the world in 2000 to being among the countries with the lowest prevalence of use for most substances in 2012. These were the results:
Fewer people arrested and incarcerated for drugs.The number of people arrested and sent to criminal courts for drug offenses declined by more than 60 percent since decriminalization.

The percentage of people in Portugal’s prison system for drug law violations also decreased dramatically, from 44 percent in 1999 to 24 percent in 2013.

More people receiving drug treatment.Between 1998 and 2011, the number of people in drug treatment increased by more than 60 percent (from approximately 23,600 to roughly 38,000). Treatment is voluntary – making Portugal’s high rates of uptake even more impressive.

Over 70 percent of those who seek treatment receive opioid-substitution therapy, the most effective treatment for opioid dependence

Reduced drug-induced deaths.The number of deaths caused by drug overdose decreased from about 80 in 2001 to just 16 in 2012.

Reduced social costs of drug misuse.A 2015 study found that, since the adoption of the new Portuguese national drugs strategy, which paved the way for decriminalization, the per capita social cost of drug misuse decreased by 18 percent

In 2013, Nuno Capaz of the Lisbon Dissuasion Commission said, “We came to the conclusion that the criminal system was not best suited to deal with this situation… The best option should be referring them to treatment… We do not force or coerce anyone. If they are willing to go by themselves, it’s because they actually want to, so the success rate is really high… We can surely say that decriminalization does not increase drug usage, and that decriminalization does not mean legalizing… It’s still illegal to use drugs in Portugal — it’s just not considered a crime. It’s possible to deal with drug users outside the criminal system.”

So why is it so hard for people to accept the outcomes of these studies? For one, government campaigns have ingrained anti-drug slogans in our brains since elementary school, so these findings are contrary to our belief system, characterized by Nancy Reagan’s “Just Say No” campaign. Since the war on drugs began with President Nixon in the 70s, immortalized by the first lady in 80s, and continued by the first President Bush, we have been engaged in a war against people affected by drug addiction. Four decades of throwing people struggling with addiction into prison, stripping people of their coping mechanisms, and offering them nothing in return except a criminal history. Secondly, if the drugs and the individual aren’t to blame, then who is? It is our responsibility as a society to help those suffering from addiction; to create a paradise for them, lend our unconditional support and sing them songs of love.

With no end to the war on drugs in sight, there are still things we can do to shift the tide and create a culture of love and support for the drug addicted person:

Stop treating the addicted person as a criminal. More than half of us have been touched in some way by addiction, and many of us know someone who is struggling with addiction today. Shifting the way we look at and treat people with addiction is the first step. They are not criminals or deviants. They are not even addicts. They are human beings—our sons and daughters, brothers and sisters, fathers and mothers, neighbors, peers, colleagues and co-workers—who are coping with an illness.

Support people in their addiction. Whether you’re a treatment provider, family member, employer or advocate, we all have a role in ensuring people who need treatment get the care they need and deserve. As we learn from Portugal, forcing people into treatment often results in high cost and poor outcomes. When someone is ready for treatment, is willing and engaged in their recovery, we see the greatest outcomes and people can begin their life free of substances.

Connect with people. Showing someone struggling with addiction that you aren’t going to turn your back on them and that you care about their recovery is the most important thing you can do. Instinctively, we want to let our loved ones “hit rock bottom” or show them how their addiction has affected us by shutting them out, but we know this does not help. Just like the rats in “Rat Park”, your love might be the thing that makes this person say maybe I don’t want the drug-laced water.